This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Monday, November 04, 2013

Weekly Australian Health IT Links – 4th November, 2013.

Here are a few I have come across the last week or so.

Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

General Comment

This week we have one enquiry starting and two reporting in Victoria. So e-Health is in for a very interesting time indeed.

Richard Willingham

Hospitals will be given greater autonomy as part of an overhaul of the Victorian health system's information and communication services, Victoria Health Minister David Davis has revealed.

Following a review of the previous Labor government's HealthSMART system, the Coalition is set to announce that health providers will now be able to choose their own system. Currently, all hospitals and other health professionals must use a mandated system.

Mr Davis is due to release a ministerial review of the sector's information and communication technology on Monday.

Decisions involving IT and communications technology across Victorian health organisations should be further devolved to local health boards, which will be responsible for owning the solutions and primarily accountable for their decisions, a ministerial review into IT throughout Victorian Health has recommended.

Released yesterday by Victorian Minister for Health David Davis, the review recommended that IT decisions be subject to normal business governance mechanisms and guided by state-wide health priorities; that the state-wide approach to IT be abandoned; and that a central governance council be created to oversee the role of IT.

For a decade, Victorian Health was embroiled in a series of setbacks and blowouts in an attempt to implement a state-wide IT strategy dubbed HealthSmart that looked to bring together the disparate IT systems used throughout the state. The HealthSmart project began as a four-year, AU$320 million project to update IT systems in hospitals and other medical facilities across the state that was due to be completed in 2007.

The Victorian Department of Health has failed to implement clinical ICT systems across 19 of the state’s health services due to poor planning and inadequate understanding of system requirements, according to a damning audit report released Wednesday.

The audit examined the status of ICT systems in eight Victorian health service providers – including four HealthSMART system rollouts – to determine if they had been appropriately planned and implemented, and benefits were being realised.

Victorian Auditor-General John Doyle said in the report that the department “significantly underestimated project scope costs and time lines”. He said it also underestimated the required clinical and other workflow redesign and change management efforts.

Summary: Victoria's statewide healthcare IT system has failed to achieve its goals, and has been criticised for putting patients at potential risk by administering wrong medications or incorrect doses.

The Victorian Department of Health has an inadequate understanding of its clinical IT systems and failed to plan adequately for 19 of its services, according to a report from the state's auditor-general.

The report (PDF) found that the department "significantly underestimated project scope, costs, and timelines, as well as the required clinical and other workflow redesign and change management efforts".

At the centre of the state's issues is the statewide HealthSmart system. The clinical IT system has only been installed at four of the 19 state hospitals that it had been planned for, and only one installation is considered to be fully implemented.

The NCTIS has previously advised licence holders of the development of a new version of the Australian Medicines Terminology (AMT) model, namely, AMT v3. This model change was based on extensive stakeholder engagement and feedback on the v2 Model since its first release for clinical use in June 2009.

The NCTIS have made the decision to not produce parallel releases of both the AMT v2 and AMT v3 and will be retiring the AMT v2 releases from May 2014. It is anticipated that the final release of the AMT v2 will be at the end of April 2014. Following this date the AMT v3 release will supersede AMT v2 and all current users will be required to migrate to the AMT v3.

A common strategy for structuring complex human systems is to demand that everything be standards-based. The standards movement has taken hold in education and healthcare, and technical standards are seen as a prerequisite for information technology.

In healthcare, standards are visible in three critical areas, typical of many sectors: 1/ Evidence-based practice, where synthesis of the latest research generates best-practice recommendations; 2/ Safety, where performance indicators flag when processes are sub-optimal; and 3/ Technical standards, especially in information systems, which are designed to ensure different technical systems can interoperate with each other, or comply with minimum standards required for safe operation. There is a belief that ‘standardisation’ will be a forcing function, with compliance ensuring the “system” moves to the desired goal – whether that be safe care, appropriate adoption of recommended practices, or technology that actually works once implemented.

Under an agreement between the International Health Terminology Standards Development Organisation (IHTSDO) and the World Organisation of Family Doctors (Wonca), a team at the Family Medicine Research Centre, University of Sydney, overseen by a Project Group made up of GPs from six countries, has developed:

• a small subset of SNOMED CT concepts commonly used in general practice internationally (known as the general practice reference set or GP RefSet)

• a map between concepts in the GP RefSet to the International Classification of Primary Care, Version 2 (ICPC-2).

The GP RefSet has been built by collecting actual “grass roots” general practice terms from seven countries around the world, amalgamating all the terms into a single list, and determining the most commonly used terms at an international level.

Yesterday, I gave a FHIR update as a keynote presentation at the International HL7 Interoperability conference (IHIC) on the subject. You can get my slides from the IHIC website or the FHIR SVN. As part of that presentation, I discussed the likely impact of FHIR on the Healthcare Integration Market.

The Productivity Commission says the federal government needs to make better use of Australians’ personal information to control the country’s ballooning health and welfare bill.

The commission’s frank assessment of government’s poor use of its information databases is likely to come to the attention of Treasurer Joe Hockey’s commission of audit, which is looking for ways to consolidate or even outsource government services.

As part of the 2010/11 Federal budget, the Government announced a $466.7 million investment over two years for a national Personally Controlled Electronic Health Record (PCEHR) system for all Australians who choose to register on-line, from 2012-2013. This initiative has the potential to be a revolutionary step for Australian health care, in terms of both consumer's access to their own health information and improvement in information which will be available to health professionals when they treat a patient.

Two dozen ThoughtWorks employees and enthusiasts from outside the company are expected to converge on the company's Melbourne offices tonight for several hours of collaborative work on an open healthcare-interchange standard that's delivering e-health to some of the world's most impoverished countries.

The software in question — OpenMRS — is a free and open-source medical records system that has an extensive development base around the world and has been successfully used during crises such as the response to the 2010 Haiti earthquake.

Its free access and open design have made OpenMRS a favourite for charity and relief organisations around the world, which can quickly roll it out to large numbers of relief staff without considering licensing costs.

A WORLD-FIRST brain scanning machine, unveiled yesterday at Macquarie University, will allow therapists to do something they haven’ t been able to do before - analyse neurological activity in people with cochlear implants.

The new magnetoencephalography or MEG machine, which can measure brain function despite electronic interference from the implants, means therapists will no longer be operating “in the dark” when they fine-tune the devices.

Blake Johnson, chief investigator with the Centre for Cognition and its Disorders, said the machine could also give rise to a new generation of implants capable of dealing with people’s idiosyncratic responses to the devices. “(And) there are vast opportunities for research,” Dr Johnson said.

Two weeks ago, I picked apart a terribly misleading, ideologically steeped Fox News story that wrongly linked the initial failure of the healthcare.gov Affordable Care Act insurance exchange to the Meaningful Use EHR incentive program. Among my many criticisms was the reporter’s apparent confusion between an actual EHR and My Medical Records, the untethered PHR offered by MMRGlobal.

In that post, I said, “I haven’t seen a whole lot of evidence that MMRGlobal isn’t much more than a patent troll.”

Bob Lorsch, CEO of that company, posted in the comments that I should put my money where my mouth is and interview him. (I had interviewed Lorsch before, but never wrote a story because of my longstanding policy of not paying attention to untethered PHRs since none that I know of has gained any market traction, despite years of hype.).

AUSTRALIA'S largest health fund has warned the federal government that insurance is now so expensive the industry is at risk of collapse without major reforms.

The situation is so dire that Medibank Private - the only government-owned fund - is even proposing insurers be allowed to discriminate against members who make the most claims in an effort to save money.

Ahead of a scoping study that will decide whether it is sold by the government, Medibank Private has called for urgent action to stop people dumping their insurance.

Medibank Private says it fears "a downward spiral of premium increases and declining participation" that will force people to use the public system and increase government healthcare costs.

Technology analyst firm Gartner is expecting Australian firms to spend a total of $77.2 billion on technology products and services in 2014, up 2.3% from this year.

Analysts today reported that businesses around the world were coming into a “digital world” in which “every budget [is] an IT budget; every company [is] a technology company; every business [is] a digital leader; and every person [is] a technology company”.